Resolving Digital Staphylococcal Osteomyelitis Using Bacteriophage—A Case Report

Abstract

Infections involving diabetic foot ulcers (DFU) are a major public health problem and have a substantial negative impact on patient outcomes. Osteomyelitis in an ulcerated foot substantially increases the difficulty of successful treatment. While literature suggests that osteomyelitis in selected patients can sometimes be treated conservatively, with no, or minimal removal of bone, we do not yet have clear treatment guidelines and the standard treatment failure fallback remains amputation. The authors report on the successful treatment, with a long term follow up, of a 63 YO diabetic female with distal phalangeal osteomyelitis using bacteriophage, a form of treatment offering the potential for improved outcomes in this era of escalating antibiotic resistance and the increasingly recognized harms associated with antibiotic therapy.

Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance

“…Some antimicrobial strategies as alternatives to antibiotics have also be developed, such as phagotherapy [ 116 , 117 ], nanotechnologies [ 118 ], antimicrobial peptides (AMP) [ 119 , 120 , 121 ], or agent mimicking AMPs [ 122 ], as well as natural compounds (such as honey [ 123 ]). These approaches have an interesting potential, but further studies are required to really understand the mechanism of action of each of these solutions and to improve their role in DFI management.…”

Contribution of Podoviridae and Myoviridae bacteriophages to the effectiveness of anti-staphylococcal therapeutic cocktails

“…Safety in the use of virulent staphylococcal bacteriophages has been shown in numerous studies in animal experiments 13 , 14 . The application of bacteriophages to treat patients with MRSA infections has also been quite successful 15 , 16 . A multicenter, randomized controlled study in a population of patients with severe clinical conditions has been conducted with a phage cocktail produced according to good manufacturing practices 17 .…”

Encapsulated bacteriophages in alginate-nanohydroxyapatite hydrogel as a novel delivery system to prevent orthopedic implant-associated infections

“…10,12,17 Several studies have explored the potential of systemic phages administration for the treatment of implant-related infections. [13][14][15][18][19][20][21] Nonetheless, experimental studies using phages-loaded biomaterials for local delivery approaches are scarce, 9,22,23 focusing on the phages release and antimicrobial activity, without simultaneously exploring the potential combination with a regeneration inductive biomaterial. Therefore, this work aims to develop a multi-functional regenerative biomaterial for local phage delivery, based on an alginate-nanohydroxyapatite (Alg-nanoHA) hydrogel system.…”